BOALA CHRON RECTOCOLITA ULCEROHEMORAGICA –COLITA ULCERATIVA
1. LOCALIZAREA SI ASPECTUL MODIFICARILOR INFLAMATORII
 poate afecta orice segment al tubului
digestive ( de la cavitatea bucala la anus )
 majoritatea cazurilor debuteaza cu
inflamatie la nivelul ileonului terminal
( ileita regionala )
2. LEZIUNILE INFLAMATORII
 segmentara discontinua “ in pietre de pavaj”
SKIP LESION
 afecteaza intregul perete intestinal ( inflamatie
profunda transmurala cu edem marcat )
MACROSCOPIC
- CD este un process transmural
- Endocopic micile ulceratii superficiale
caracterizeaza boala moderata
- In boala activa ulceratiile stelate sunt
longitudinale si transversale pt a demarca insule
de mucoasa care frecvent sunt normale
- Aspectul de “piatra de pavaj” este caracteristica
CD atat endoscopic ca si la tranzit baritat
- Ca si un UC, se pot forma pseudopolipi
- CD activa este caracterizata de inflamatie focala
si formare de fistule – fibroza si strictura
intestinului
MICROSCOPIC
- Primele leziuni sunt ulceratiile aftoase si
abcesele criptice focale cu agregate
macrophage care formeaza granuloame in toate
straturile intestinului
- Granuloamele pot fi vazute in noduli limfatici,
mezenter, peritoneu, ficat si pancreas
- Desi granuloamele sunt patognomonice pt CD
acestea sunt gasite rar la biopsia mucoasa
- CD include si prezenta de aggregate limfoide in
stratus submucos si subseros departe de aria
ulceratiilor, inflamatie transmurala care este
acompaniata de fisuri care penetreaza adanc in
peretele intestinal si cateodata formeaza fistule
sau abcese locale.
 este limitata la colon si rect
 leziuni continue, superficiale
 limitatea doar la mucoasa ( edem usor )
MACROSCOPIC
- in inflamatia moderata mucoasa este
eritematoasa si are un strat granular fin cu
aspect de glaspapir
- in boala severa mucoasa este hemoragica,
edematoasa si ulcerata
- in boala de lunga durata, polipii
inflamati( pseudopolipi) pot fi prezenti care
rezultat al regenerarii epiteliale
- mucoasa poate aparea normal in remisie dar
la pacientii cu boala de multi ani apare
atrofica si intregul colon devine ingust si scurt.
- Pacientii cu boala fulminanta pot dezvolta
colita toxica sau megacolon unde peretii
intestinului se subtiaza si mucoasa este sever
ulcerata – poate duce la perforatie
MICROSCOPIC
- Procesul este limitat la mucoasa si
submucoasa superficiala cu stratul profund
neafectat decat in boala fulminanta
- In UC sunt 2 aspecte histologice care
sugereaza cronicitatea si ajuta la diferentierea
intre colita infectioasa si cea autolimitanta
- 1 arhitectura criptica a colonului este
distorsionata; ciptele pot fi bifide si reduse la
numar ,deseori cu o distanta intre baza criptei
si muscularis mucosae
- 2 unii pacienti au plasmoide bazale si multiple
aggregate limfoide bazale.
- Congestia vasculara mucoasa cu edem si
hemoragie focala si infiltrate celulare
inflamatorii cu neutrofile,limfocite, plasmoide
si macrophage pot fi prezente
- Neutrofilele invadeaza epiteliul de obicei
criptele ducand la criptita si in final la abcese
criptice
 3. CORESPONDENTUL ENDOSCOPIC AL MODIFICARILOR ANATOMOPATOLOGICE
 ulceratii profunde, serpiginoase, difuze  ulceratii continue

4. SIMPTOMATOLOGIA
- comuna pana la un anumit punct
- dureri abdominale, inapetenta, varsaturi, diaree, crampe intestinale severe, scadere ponderala
- ambele boli pot fi insotite de manifestari extradigestive : artrita, piodermita gangrenoasa,
iridociclita/uveita, eritem nodos, spondilita anchilozanta
 scaun cu aspect steatoreic  Diaree cu sange, mucus, puroi
 simptome sistemice  Tenesme, febra, hematochezie, scadere ponderala
 obstructie de IG  Asociata frecvent cu colangita sclerozanta
 prezinta frecvent stenoze digestive, fistule primara, cancer colorectal
si abcese perianale
 formatiuni pseudotumorale la palpare
abdominal
COMPLICATII - Megacolon toxic
- Digestive:stenoze, fistule, abcese perianale - Displazie asociata cu masa lezata
- Ale tratamentului: sdr de intestine scurt, - Adenocarcinom in situ
reactii adverse ale medicamentelor
- Extradigestive: dermatologice, oftalmologice,
hematologice, hepatobiliare, genitourinare,
pancreatice, pulmonare, cardiovasculare, retard
de crestere la copii, intarzierea dezvoltarii sexual
la adolescent
5. PARACLINIC
Anticorpi ASCA- anticorpii anti-Saccharomyces Anticorpi ANCA-Anticorpii anti citoplasmatici neutrofilici
cerevisiae
6. PATOLOGIC
 Este considerata o boala autoimuna
 Prezenta granuloamelor la biopsia digestiva
7. TRATAMENT
- Ambele boli inflamatorii pot beneficia de tratament imunosupresor : corticosteroizi, anti-TNF, azatioprina,
metotrexat, 6-mercaptopurina
 Excizia chirurgicala a unui segment  Colectomia are valoare curativa
digestive afectat este insotit de recurente  Mesalazina este eficcienta
 Antibioticele de lunga durata sunt mai
eficiente !!!! Se afla in studiu terapia helmintica (cu paraziti )
Table 295-5 Different Clinical, Endoscopic, and Radiographic Features

  Ulcerative Colitis Crohn's Disease

Clinical 
Gross blood in stool Yes Occasionally
Mucus Yes Occasionally
Systemic symptoms Occasionally Frequently
Pain Occasionally Frequently
Abdominal mass Rarely Yes
Significant perineal disease No Frequently
Fistulas No Yes
Small intestinal obstruction No Frequently
Colonic obstruction Rarely Frequently
Response to antibiotics No Yes
Recurrence after surgery No Yes
ANCA-positive Frequently Rarely
ASCA-positive Rarely Frequently
Endoscopic 
Rectal sparing Rarely Frequently
Continuous disease Yes Occasionally
"Cobblestoning" No Yes
Granuloma on biopsy No Occasionally
Radiographic 
Small bowel significantly abnormal No Yes
Abnormal terminal ileum No Yes
Segmental colitis No Yes
Asymmetric colitis No Yes
Stricture Occasionally Frequently

Abbreviations: ANCA, antineutrophil cytoplasm antibody; ASCA, anti-

Saccharomycescerevisiae antibody.

Table 295-7 Oral 5-ASA Preparations

Preparation Formulation Delivery Dosing Per Day

Azo-Bond 
Sulfasalazine (500 mg) Sulfapyridine-5-ASA Colon 3–6 g (acute)2–4 g
(Azulfidine) (maintenance)
Olsalazine (250 mg) 5-ASA-5-ASA Colon 1–3 g
(Dipentum)
Balsalazide (750 mg) Aminobenzoyl-alanine-5- Colon 6.75–9 g
(Colazal) ASA
Delayed-Release 
Mesalamine (400, 800 mg) Eudragit S (pH 7) Distal ileum- 2.4–4.8 g (acute)1.6–4.8 g
(Asacol) colon (maintenance)
Mesalamine (1.2 g) MMX mesalamine Ileum-colon 2.4–4.8 g
(Lialda) (SPD476)
Controlled-Release 
Mesalamine (250, 500, Ethylcellulose Stomach- 2–4 g (acute)1.5–4 g
1000 mg) (Pentasa) microgranules colon (maintenance)
Delayed and Extended-Release 
Mesalamine (.375 g) Intellicor extended- Ileum-colon 1.5 g (maintenance)
(Apriso) release mechanism
Table 295-8 Indications for Surgery
Ulcerative Colitis Crohn's Disease
Intractable disease
Fulminant disease
Toxic megacolon
Colonic perforation
Massive colonic hemorrhage
Extracolonic disease
Colonic obstruction
Colon cancer prophylaxis
Colon dysplasia or cancer
Small Intestine
Stricture and obstruction unresponsive to medical therapy
Massive hemorrhage
Refractory fistula
Abscess
Colon and rectum
Intractable disease
Fulminant disease
Perianal disease unresponsive to medical therapy
Refractory fistula
Colonic obstruction
Cancer prophylaxis
Colon dysplasia or cancer